7 ways to help kids cope with coronavirus (COVID-19) anxiety

If the ongoing spread of coronavirus (COVID-19) is causing anxiety, stress and uncertainty for grownups, consider how troubling it may be for children.

Depending on their age and media exposure, children may know more about the virus than grownups think. And even if unaware, children still might sense tension and anxiety from adults around them.

Here, CHOC Children’s pediatric psychologist Dr. Sabrina Stutz offers seven things parents can do to help reduce their children’s anxiety about COVID-19.

Meet children’s concerns with validation, compassion

  • Listen carefully to their concerns and learn where they heard their information. Validate their fears by saying something like, “It can be frightening when a new illness comes around that we don’t know everything about.”
  • Gently correct any misconceptions they may have heard and encourage them to continue to ask questions.
  • Maintaining a routine can provide children a sense of security. Keeping a usual schedule – including school, activities and chores – will protect mental and physical health.

Stick to developmentally appropriate facts

  • ​Avoid having adult-level conversations about COVID-19 around children. Similarly, carefully monitor children’s exposure to media reports about the virus.
  • Answer questions with brief, developmentally appropriate explanations. For example, you might tell a young child, “coronavirus is a new type of cold/flu, and so it is important for us to wash our hands more and sneeze in our elbows to keep healthy.”
  • Remind children that doctors and other experts around the world are working hard to stop the virus. This can help kids understand that smart, capable people are taking action.

Reassure kids by empowering them

  • Telling kids how they can help provides a sense of agency and can turn anxiety into an actionable goal.
  • Reassure children that they can protect themselves and others by practicing proper hand-washing and cough etiquette and taking other healthy steps.
  • Kids can also be included in other family-wide preparations. For example, if you were preparing for the possibility of being home for a while, ask the child what they might want to snack on or what activities they might enjoy during that time.

Look for kid-friendly methods

  • Make learning about hand-washing and other preventative measures fun. Help kids learn about germs by giving them some lotion and then sprinkling glitter on their hands. Tel them the glitter is like germs, and then ask the child to try to wipe it off with a paper towel or just water. They won’t get far! Then you can explain how soap and warm water removes the glitter – and germs – best.
  • Teach kids how long to wash hands for by singing a 20- to 30-second song together. “Happy Birthday” or the “ABCs” are classics. You can also be creative and estimate 20-to-30 seconds of any song the child likes.

Emphasize kindness

  • As always, it is helpful to teach kids to continue to be kind to all people, regardless of their country of origin or their appearance. Kindness is always possible – even when they feel afraid.
  • To help children more realistically assess risk, educate children that most people who visit the doctor or wear a mask probably don’t have the virus.
  • It is important to remind children that we are all trying our best to stay healthy and it’s not anyone’s fault if they do get sick.

Remember to model positive behavior

  • Parents who show good coping skills can help reassure kids that they are safe. After all, kids learn from their parents how to react in new situations.
  • Remember that kids make mistakes. If your child accidentally does not wash their hands or doesn’t sneeze into their elbow, gently remind them. Scaring children with the potential consequences of their mistakes is not helpful.
  • Adults should model self-care behaviors: Maintain activities and sleep schedules. Eat healthfully and practice hand hygiene and cough etiquette.
  • It’s also helpful for grownups to limit their own media consumption around coronavirus (COVID-19) and stick to a few trusted resources such as the Centers for Disease Control to prevent information overload and anxiety.

Watch for behavior changes

  • Changes in a child’s sleep, appetite, interest in being with friends or leaving the house, or levels of reassurance seeking, as well as excessive hand-washing can be signs that more help is needed.
  • If basic stress reduction techniques like deep breathing, distraction or guided imagery don’t help, reach out to your primary care provider for additional support.
Learn more about mental health services at CHOC

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How to help children cope with grief

It’s difficult for adults to make sense of a tragedy or unexpected death, so consider how difficult it can be for children to do the same. Even events that occur far away – or the unexpected death of a celebrity – can trigger a stress response in children. Here are some ways parents can help.

Monitor your child’s news and social media intake and keep their routine and schedule as normal as possible. If your child is prone to anxiety, reassure them of their safety and ensure they are not dwelling on the tragedy.

Honor your child’s connection to the deceased – even if he or she didn’t know them personally. Talk about why this person was important to them, and the qualities and values that made this person feel special to them. Ask what your child wants to do to pay their respects or process the tragedy. This can be as simple as saying a prayer for the individuals left behind or donating to an organization important to the deceased.

Parents should also consider the five E’s of helping a child navigate emotions that come with a traumatic event:

Explore what your child already knows in a gentle and calm manner. You can start with a neutral question inquiring about how their school day was.

Explain what has happened in a way that your child can understand based on their age.

  • Address any misinformation your child might have picked up at school. Help them understand that although a sad and/or scary thing did happen, adults work hard to keep children safe daily.
  • Limit information you provide to your child to the questions they ask you. This will help avoid overwhelming them with information they may not already have been exposed to.
  • Provide examples of ways you and others in your community keep your child safe every day.

Express to your child that feelings are normal, and it is OK to feel sad, mad or angry when a tragic event occurs. Remember to reduce media exposure after a traumatic event, as repeated exposure to the event has been associated with psychological distress and intensifying already heightened emotions.

Emotionally model for your child healthy expression of feelings because children take their cues from their parents. Describe how you cope with your distressing emotions (e.g., “When I feel sad, I talk about it with someone who makes me feel safe or I take three deep breaths.”).

Ensure stability by continuing to adhere to your child’s daily routine. This will provide them with a sense of reassurance and safety during a chaotic time. Engaging in a daily routine is not meant to ignore what has happened, rather to continue to provide the child with structure, stability and predictability.

Additional resources

In the wake of a tragic event, it can be difficult for parents to find the words to talk with children and teens. Below are resources and suggestions for parents on how to discuss difficult topics with their children:

When to get help

Grief and shock are common after a loss or community tragedy. When this lasts longer than two to four weeks and is constant and begins to affect everyday life (schoolwork, interactions with family and friends), then therapy might be appropriate.

If you are struggling to help your child process a traumatic event, or if you feel your child could benefit from additional support, ask your pediatrician for a referral to a pediatric psychologist or psychiatrist.

Below are a few resources in Orange County with expertise in children:

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts.

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Three gifts support mental health, research and neonatal care

CHOC Children’s is so grateful to recently have received three very generous gifts that will help CHOC continue to care for more than 185,000 babies, kids and teens each year. CHOC believes that all children deserve a chance at a happy, healthy childhood.

Transformational gift to benefit the pediatric mental health system of care

CHOC received a transformational gift from the Cherese Mari Laulhere Foundation to enhance and expand its pediatric mental health system of care. The announcement comes on the heels of the Conditions of Children in Orange County report, which highlights alarming increase in the number of children hospitalized in the county for mental illness.

The gift from the Cherese Mari Laulhere Foundation will:

  • Endow CHOC’s mental health inpatient center. Opened in April 2018 for children ages 3 to 17, the center is the only inpatient facility in Orange County that offers specialized programs for kids younger than 12. The center will now be named the Cherese Mari Laulhere Mental Health Inpatient Cente
  • Establish the Cherese Mari Laulhere Young Child Clinic for children ages 3 to 18 who are experiencing behavioral and emotional challenges, mental health issues and school readiness challenges.
  • Expand CHOC’s Intensive Outpatient Program, a mental health treatment program for high schoolers with moderate to severe symptoms of anxiety, depression or other symptoms related to mental health conditions. The program will be expanded to middle school-aged children.
  • Advance trauma-informed care, including providing tools to pediatricians to help in identifying adverse childhood experiences, and connecting patients and families with resources.
Cherese Mari Laulhere

“Our donations are gifts from our daughter, who brought so much light and love into this world. As someone who advocated for the underserved, Cherese would be very proud of her role in supporting CHOC’s mental health efforts and helping change the trajectory of thousands of young lives,” says Cherese’s parents, Chris and Larry.

Learn more about this gift to CHOC Children’s.

$8 million to advance research for rare disorder

An $8 million gift from the Foundation of Caring will help CHOC advance research for a rare lysosomal storage disease, ultimately leading to an improved understanding and more effective treatments.

The gift will support CHOC researchers working to develop next-generation therapies for Pompe disease, a lysosomal storage disease wherein glycogen builds up in the body’s cells and causes life-threatening heart failure and muscle weakness in affected babies. In honor of the gift, the program will be named the Foundation of Caring Lysosomal Storage Disorder Program at CHOC Children’s.

The work of Dr. Raymond Wang, a CHOC metabolic disorders specialist and director of the Foundation of Caring Lysosomal Storage Disorder Program, drew the attention of the Foundation of Caring several years ago when Dr. Wang began treating the great-granddaughter of the Foundation’s founder after she was diagnosed with Pompe disease.

Dr. Raymond Wang, a CHOC metabolic disorders specialist and director of the Foundation of Caring Lysosomal Storage Disorder Program

With previous support from the Foundation of Caring, Dr. Wang and his team have already made significant strides in its study of Pompe disease, having built a growing research team that’s used CRISPR/Cas9 technology to edit the genome to create animal models of Pompe disease. The Foundation of Caring’s gift will allow Dr. Wang and his team to expand upon this work and use CRISPR to cure Pompe disease and lysosomal storage disorders.

“We are so pleased to support the important work of Dr. Wang and his team at CHOC to help find better treatment or, even better, a cure for Pompe disease for patients affected by the condition worldwide,” says the Foundation of Caring Board of Directors.

Learn more about this gift to CHOC Children’s.

$2 million to CHOC’s neonatal intensive care unit

Newborn babies requiring critical care have gained a big ally in the William, Jeff and Jennifer Gross Foundation. A recent $2 million gift to the neonatal intensive care unit (NICU) on CHOC’s main campus in Orange rounds the Foundation’s support of CHOC’s neonatal services to $7 million in the past year.

choc nicu

Many hospitals offer intensive care units but only a select few are rated by the American Academy of Pediatrics as Level 4 – the highest rating available – and even fewer are ranked among the best in the nation, according to U.S. News & World Report. CHOC’s program features three NICUs, a team of board-certified neonatologists and special units for the smallest preemies, infants who need complex surgery, and babies who have neurological and cardiac concerns.

“CHOC’s neonatal services are unlike anything else offered on the West Coast, providing the highest levels of care and tremendous hope to families in the region. We are honored to continue our commitment to CHOC and the care of newborn babies,” says Jeff Gross.

Learn more about this gift to CHOC Children’s.

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When distress is something more

When is distress something more serious? When does it become something that warrants specialized help?

Everyone experiences distress from time to time. Children and teenagers can go through spells where they seem very upset. However, people who struggle with a mental health disorder tend to experience distress more regularly and more strongly. When should you think about going to a professional for guidance? Below are a few characteristics that can help in figuring out the extend of your child or adolescent’s distress. Note this is not intended to replace a specialized medical assessment. Always seek immediate help if a child engages in unsafe behavior or talks about wanting to hurt himself or someone else.

Typical distress: The upsetting symptoms should last a few hours or a few days. This may look like:

  • After a breakup, your adolescent cries for a few days.
  • He complains of a stomachache after eating too much ice cream.
  • She has a temper tantrum when she is tired.

Distress that may require professional guidance: The upsetting symptoms are persistent and last longer then a few days. This may look like:

  • Crying regularly and not knowing why
  • Complaining about frequent stomachaches or headaches, with no known medical, that keep them from attending school
  • Having frequent tantrums or being intensely irritable much of the time
  • Consistently not meeting milestones for his or her age, or you feel there could be a problem with their development

Typical distress: Difficulties take place in one setting such as school, home, with friends, or in the community. This may look like:

  • Before a test or presentation at school, your child gets the feeling of butterflies in her stomach.
  • Your son misbehaves at home, but follows the rules at school.

Distress that may require professional guidance: Difficulties are pervasive and take place in more than one setting. This may look like:

  • After a poor grade on an exam, your child feels worthless or helpless all the time (at school, at home and with friends) and does not engage in regular activities.
  • Your child doesn’t like to eat at parties and at school for fear of gaining weight.
  • He throws severe tantrums at home and at preschool.

Typical distress: Generally, your child is doing well across most settings (at school, with friends and family relationships, at work if applicable). This may look like:

  • Your son feels betrayed by a friend; however, he continues to hang out with your family, and school performance stays the same.
  • Your daughter is usually a good student, but experienced a recent decline in grades due to a change in teachers.
  • Your son has a few friends in the neighborhood and one friend at school, but hangs out with family members.

Distress that may require professional guidance: Your child’s distress interferes with normal functioning, and symptoms get in the way of everyday life, such as school, friends, family relationships and work). This may look like:

  • Your daughter is spending more and more time alone, and avoiding social activities with friends or family.
  • Your son has lost interest in activities he used to enjoy doing.
  • Your daughter is not interested in playing with other children, or has difficulty making friends.
  • Your son is experimenting or engaging with alcohol and drug use, and is not engaged with family and friends, or shows a decrease in school or job achievement.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts.

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What do psychiatric medications do?

By Alice Kim, clinical pharmacist at CHOC Children’s

Mental health is an important part of overall health. Therapy is important, but sometimes, medication is necessary to improve or maintain our mental health. These psychiatric medications are safe and effective when taken appropriately under a doctor’s supervision.

Psychiatric medications influence the chemicals in our brains that regulate emotions and thought patterns. They can reduce symptoms such as loss of energy and lack of concentration, so therapy can be more effective.

Psychiatric medications include a variety of drugs prescribed to treat different types of mental health problems, or to reduce symptoms associated with these problems. There are five main types of psychiatric medication: antidepressants, antipsychotics, stimulants, anti-anxiety, and mood stabilizers.

Antidepressants help reduce feelings of sadness or depressed mood and anxiety as well as suicidal thoughts. They do not, however, “make people happy” or change their personalities. Possible side effects of antidepressants include drowsiness or insomnia, constipation, weight gain, tremors and dry mouth.

Antipsychotic medications help reduce or, in some cases, eliminate hearing unwanted voices or having very fearful thoughts. These medications can promote thinking clearly, staying focused on reality, and feeling organized and calm. They also can help you sleep better and communicate more effectively. Possible side effects of these medication include drowsiness, increased appetite and weight gain, blurred vision, constipation, dry mouth, dizziness, restlessness, shakes and twitches, and muscle stiffness. Rare side effects include seizures and problems controlling internal body temperature.

Stimulants and related medicines help improve concentration and attention spans in both children and adults by reducing hyperactivity and impulsiveness. Possible side effects include trouble falling asleep, decreased appetite and weight loss. Less common side effects can include headaches, stomachaches, irritability, rapid pulse or increased blood pressure. These often go away within a few weeks after stopping use or if your health care provider lowers your dose.

 Anti-anxiety medication can reduce anxiety and help you feel more relaxed. These medicines are generally safe when used as prescribed and usually are temporary, since long-term use can cause dependency. Call your doctor right away if you experience headaches, slurred speech, confusion, dizziness, increased nervousness or excitability when taking these medications.

Mood stabilizers help reduce or eliminate extremes of high or low moods and related symptoms. They should not keep you from experiencing the normal ups and downs of life, though. Side effects can include an upset stomach, drowsiness, weight gain, dizziness, shaking, blurred vision, confusion, or lack of coordination.

How to deal with side effects of medication

Side effects often get better with continued medication therapy. For side effects of mental health medication that linger, here are a few tips:

Side Effect What can be done
Dry mouth Try sugarless gum or mints
Constipation Drink plenty of water and eat lots of fruits and vegetables. Ask your doctor or pharmacist about over-the-counter laxatives.
Nausea or upset stomach Take your medication with a meal. Ask your doctor about anti-nausea medication.
Feeling sleepy Ask about changing the time when you take the medication.

Despite the prevalence of mental illness in the U.S. – one in five people have a diagnosable mental health disorder—an unnecessary stigma remains surrounding seeking treatment and utilizing prescribed medication. If you have a mental illness, know that you are not alone. For those without a mental health condition, educate people around you about the reality that mental illness is more common than people realize and speak out against stigma. By improving mental health education, we can challenge our misinformation and negative attitudes.

Stay informed about mental health.

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts.

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